Neuromuscular training for chronic ankle instability

The Effect of Additional Neuromuscular Training on Peri-Ankle Muscle Morphology and Function in Chronic Ankle Instability Subjects: A Randomized Controlled Trial

BACKGROUND

Lateral ankle sprain is one of the most common musculoskeletal issues during sports and activities of daily living. This study investigated the effect of combined neuromuscular training and conventional training (including strengthening, range of motion, and balance exercises) on muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with chronic ankle instability (CAI).

HYPOTHESIS

The combination of neuromuscular and conventional training programs might result in additional benefits on the morphology of muscle, dynamic balance, and functional capacity in subjects with CAI.

STUDY DESIGN

A single-blind parallel-arm randomized controlled trial.

LEVEL OF EVIDENCE

Level 2.

METHODS

A total of 34 participants with CAI were divided randomly into experimental (EG) and control groups (CG). The EG received conventional and neuromuscular training, while the CG underwent conventional training. Cross-sectional areas of the peroneus longus and tibialis anterior muscles were measured using ultrasonography. Measurements included reaching direction distance, ankle instability, and the foot and ankle outcome score, all evaluated before and immediately after 12 intervention sessions and 4 weeks later in the follow-up phase.

RESULTS

Repeated-measures analysis of variance (ANOVA) revealed significant improvement in the EG, particularly in the cross-sectional area of the tibialis anterior muscle on the injured side and the posteromedial reaching direction displacement of the Y balance test. Moreover, the EG's foot and ankle outcome scores increased significantly compared with the CG (P < 0.05). However, the group effect size ranged from minor to moderate (Hedges g, 0.40-0.73).

CONCLUSION

Combining neuromuscular and conventional training programs yields greater benefits than conventional training alone regarding tibialis anterior muscle morphology, posteromedial dynamic balance, and functional capacity in persons with CAI.

CLINICAL RELEVANCE

The combination of neuromuscular and conventional training programs could enhance muscle morphology, dynamic balance, perceived ankle instability, and functional capacity in persons with CAI.

The effect of neuromuscular and vestibular-ocular reflex training program on balance, isokinetic muscle strength and proprioception in people with chronic ankle instability

OBJECTIVE

This study aimed to compare and investigate the effectiveness of neuromuscular exercise combined with vestibular-ocular reflex training and only neuromuscular exercise training on balance, isokinetic muscle strength, and proprioception in chronic ankle instability (CAI).

METHOD

The study included 20 patients with unilateral CAI. The functional status was evaluated with the Foot and Ankle Ability Measure (FAAM). The star-excursion balance test was used for dynamic balance, and the joint position sense test assessed proprioception. Ankle concentric muscle strength was measured by an isokinetic dynamometer. The subjects were randomly divided into neuromuscular and vestibular-ocular reflex training (VOG, n = 10) and neuromuscular training group (NG, n = 10). Both rehabilitation protocols were applied for four weeks.

RESULTS

Although VOG had higher means of all parameters, no superiority was found between the two groups in post-treatment results. However, the VOG significantly improved FAAM scores at the sixth-month follow-up than NG (P < .05). In the linear regression analysis, the post-treatment proprioception inversion-eversion for unstable side and FAAM- S were found to be independent factors of FAAM-S scores at the six months follow -up in VOG. Post-treatment isokinetic strength for inversion of unstable side (120 º /s) and FAAM- S were determined as predictor factors of FAAM- S scores at the six months follow -up (p < .05) in NG.

CONCLUSION

The Neuromuscular combined with vestibular-ocular reflex training protocol effectively managed unilateral CAI. Furthermore, it may be considered an effective strategy for clinical outcomes for a long-term period in terms of functional status.

Effects of whole-body vibration on sensorimotor deficits and brain plasticity among people with chronic ankle instability: a study protocol for a single-blind randomized controlled trial

BACKGROUND

Chronic ankle instability (CAI) is a form of musculoskeletal disease that can occur after a lateral ankle sprain, and it is characterized by pain, recurrent ankle sprains, a feeling of "giving way" at the ankle joint, and sensorimotor deficits. There has been increasing evidence to suggest that plastic changes in the brain after the initial injury play an important role in CAI. As one modality to treat CAI, whole-body vibration (WBV) has been found to be beneficial for treating the sensorimotor deficits accompanying CAI, but whether these benefits are associated with brain plasticity remains unknown. Therefore, the current study aims to investigate the effect of WBV on sensorimotor deficits and determine its correlation with plastic changes in the brain.

METHODS

The present study is a single-blind randomized controlled trial. A total of 80 participants with CAI recruited from the university and local communities will be divided into 4 groups: whole-body vibration and balance training (WBVBT), balance training (BT), whole-body vibration (WBV), and control group. Participants will be given the WBV intervention (25-38 Hz, 1.3-2 mm, 3-time per week, 6-week) supervised by a professional therapist. Primary outcome measures are sensorimotor function including strength, balance, proprioception and functional performance. Brain plasticity will be evaluated by corticomotor excitability, inhibition, and representation of muscles, as measured by transcranial magnetic stimulation. Activation of brain areas will be assessed through functional near-infrared spectroscopy. Secondary outcome measures are self-reported functional outcomes involving the Cumberland Ankle Instability Tool and the Foot and Ankle Ability Measure. All tests will be conducted before and after the WBV intervention, and at 2-week follow-up. Per‑protocol and intention-to-treat analysis will be applied if any participants withdraw.

DISCUSSION

This is the first trial to investigate the role of brain plasticity in sensorimotor changes brought by WBV for individuals with CAI. As plastic changes in the brain have been an increasingly important aspect in CAI, the results of the current study can provide insight into the treatment of CAI from the perspective of brain plasticity.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300068972); registered on 02 March 2023.

EVALUATION OF ANKLE MOVEMENTS ON A SUDDEN INVERSION PLATFORM

ABSTRACT Introduction: Ankle sprains are frequent in sports activities and can lead to joint instability with clinical and performance consequences. Sudden ankle inversion platforms have been used to study the mechanism of ankle sprain. Objectives: To test a static platform that simulates the movement of ankle sprain (sudden inversion) in soccer players. Methods: A platform was developed to perform the sudden movement of an ankle sprain dissociated in three axes: inversion, plantar flexion, and medial rotation. A computer program was also created to read the angular velocity and the time to reach the maximum amplitude of the three axes of movement, synchronized with the platform movements. Thirty soccer players without ankle sprains were evaluated on the sudden inversion platform. Each athlete performed 10 randomly initiated tests, with five per leg. Results: There was no statistical difference in angular velocity or time to reach maximum range of motion of plantar flexion and medial rotation between the tests. During the tests, the angular velocity of the inversion increased. Conclusion: The sudden static platform evaluated the movements performed by the ankle during the sprain reliably in the 10 tests with no difference in the mechanical behavior. Level of evidence I; Therapeutic studies - Investigation of treatment outcomes.

AVALIAÇÃO DOS MOVIMENTOS DO TORNOZELO NA PLATAFORMA DE INVERSÃO SÚBITA

RESUMO Introdução: A entorse do tornozelo é frequente nas atividades esportivas, podendo levar à instabilidade articular com consequências clínicas e de desempenho. As plataformas de inversão súbita do tornozelo têm sido usadas para estudar o mecanismo de entorse do tornozelo. Objetivos: Testar uma plataforma estática que simule o movimento de entorse do tornozelo (inversão súbita) em jogadores de futebol. Métodos: A plataforma foi desenvolvida para realizar o movimento súbito da entorse de tornozelo dissociado em três eixos: inversão, flexão plantar e rotação medial. Também foi criado um programa de computador para leitura da velocidade angular e do tempo para atingir a amplitude máxima dos três eixos de movimento, sincronizados com os movimentos da plataforma. Trinta jogadores de futebol sem entorse de tornozelo foram avaliados na plataforma súbita. Cada atleta fez 10 testes, iniciados de forma aleatória, sendo cinco em cada perna. Resultados: Entre os testes, não houve diferença estatística das velocidades angulares e tempo para atingir a amplitude máxima do movimento de flexão plantar e rotação medial. Durante os testes, a velocidade angular da inversão aumentou. Conclusão: A plataforma estática súbita, avaliada em 10 tentativas, foi confiável para avaliar os movimentos executados pelo tornozelo durante a entorse, e não houve diferença de comportamento mecânico. Nível de evidência I; Estudos terapêuticos - Investigação dos resultados do tratamento.

A critical appraisal of ankle rehabilitative interventions

Introduction Lateral ankle sprain is a common musculoskeletal pathology. Functional exercise progression is vital to restore full function. Aim The aim of this study was to compare the electromyographical response to a standard balance task on one stable and four unstable surfaces. Participants Twenty subjects (5 male, 15 females; age at 23 ± 7.1 years) were recruited to participate in the study. Methods A gym-based single session cross over design was used to compare peak and mean surface EMG (sEMG) activity of the Peroneus Longus, Tibilais Anterior and medial head of the gastrocnemius muscles whilst performing a standardized balance task on one stable surface and four unstable surfaces stable surface. Results A significant main effect for surface was found. Post-hoc testing revealed that the Floor and Trampoline (Trampet) elicited similar mean sEMG response. Discussion The results of the study propose a safe and stepwise progressive rehabilitation regime following ankle injury whilst considering the healing process of the injured structure.

Reliability and usefulness of the single leg heel raise balance test in patients with chronic ankle instability

We aimed to analyze the differences in static (including conventional and modified [single-leg heel-raise balance]) and dynamic postural stability and muscle endurance between patients with chronic ankle instability (CAI) and healthy controls, and to determine the reliability and usefulness of the single-leg heel-raise balance test in patients with CAI. In total, 26 patients with CAI and 26 healthy controls were enrolled. Postural stability was assessed using a postural stabilometry system. Muscle endurance was measured in dorsiflexion and plantarflexion using an isokinetic device. Modified static postural stability (P < 0.001) and dynamic postural stability (P < 0.001) were significantly poorer in the affected ankles of patients with CAI than in the controls. Plantarflexion endurance was significantly lower in the affected ankles of the patients with CAI than in the controls (P = 0.023). Modified static postural stability significantly correlated with plantarflexion endurance in both groups (CAI group: r = - 0.470, P = 0.015; healthy controls group: r = - 0.413, P = 0.036). Plantarflexion endurance was a significant risk factor for modified static postural stability in both the CAI group (R² = 0.221, P = 0.015) and healthy controls (R² = 0.170, P = 0.036). Given the reliability of the modified static postural stability test, clinicians and therapists should consider using it to assess improvements in postural stability and muscle endurance in patients with CAI before and after rehabilitation.

Comparison of the Effect of Resistance and Balance Training on Isokinetic Eversion Strength, Dynamic Balance, Hop Test, and Ankle Score in Ankle Sprain

Ankle sprain is a commonly recurring sports injury. This study aimed to compare the rehabilitation effects of resistance and balance training programs in patients with recurrent ankle sprain. Patients with recurrent lateral ankle sprain completed a home-based rehabilitation program comprising resistance training (RT; n = 27) or balance training (BT; n = 27). RT consisted of exercises using elastic tube bands, and BT consisted mainly of exercises performed using a variety of balance tools. Exercises were performed for 6 weeks, twice a day for 20 min, 5 days per week. Isokinetic eversion strength, Y-Balance test and hop tests, and foot and ankle outcome score (FAOS) were evaluated. Both RT and BT significantly improved strength and dynamic balance (p < 0.05). Compared to RT, BT also significantly improved the outcome of the crossover hop test (p = 0.008). The changes reflected group and time in pain (p = 0.022), sports (p = 0.027), and quality of life (p = 0.033) of FAOS were significantly greater in BT than RT.

Effects of neuromuscular training on psychomotor development and active joint position sense in school children

As psychomotor development occurs in a specific social context, the environment in which a child is reared is important. The randomized study involved forty-five school children between 8 and 10 years. They were assigned to a control group (n = 23) and a neuromuscular training group (n = 22). A neuromuscular intervention for six weeks, on two nonconsecutive days, and in a circuit with 30-second stations was performed. The psychomotor development was evaluated through a psychomotor battery and the active joint position sense through the positional error. In the control group, the positional error decreased significantly in the shoulder (p < 0.001) and hip (p < 0.001), while the scores of motor function increased significantly which included balance (p < 0.001), spatio-temporal structuring (p = 0.022), global praxia (p = 0.002), and fine praxia (p = 0.003). In the neuromuscular training group, the positional error decreased significantly in the shoulder (p = 0.015), elbow (p = 0.015), wrist (p < 0.001), hip (p < 0.001), knee (p < 0.001), and ankle (p < 0.001), while the motor function scores increased significantly which included tonicity (p < 0.001), balance (p < 0.001), notion of the body (p < 0.001), spatio-temporal structuring (p < 0.001), global praxia (p < 0.001), and fine praxia (p < 0.001). A six-week neuromuscular training improved active joint position sense and psychomotor development in children.

The effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis: a pilot study

[Purpose] To determine the effects of progressive neuromuscular training on postural balance and functionality in elderly patients with knee osteoarthritis (OA). [Subjects and Methods] Eleven participants between 60 and 75 years of age performed the progressive neuromuscular training for 8 weeks and 4 weeks of follow-up. The area and velocity of the center of pressure were measured on a force platform, and the functionality was measured with a Western Ontario and McMaster Universities Osteoarthritis Index. [Results] The area and velocity (anteroposterior and mediolateral directions) of the center of pressure showed significant differences after 4 and 8 weeks of intervention. Additionally, the global score and some questionnaire dimensions (pain and physical function) showed significant differences after 4 and 8 weeks of intervention. These changes were maintained in all variables at week 4 of follow-up. [Conclusion] The intervention generated improvements in balance and functionality in elderly patients with knee OA. These changes were observed after 4 weeks of training and were maintained 4 weeks after the end of the intervention.